title: Tobacco, nicotine and harm reduction.
abstract: OBJECTIVE
  Tobacco smoking, sustained by nicotine dependence, is a chronic relapsing disorder, which in many cases results in lifelong cigarette use and consequent death of one out of two lifelong smokers from a disease caused by their smoking. Most toxicity due to cigarette smoking is related to the burning process.
  
  
  METHODS
  Models of harm reduction applied to tobacco suggest that use of non-combustible, less toxic, nicotine-containing products as a substitute for cigarette smoking would reduce the death toll arising from tobacco use. Available options include medicinal nicotine and smokeless tobacco products.
  
  
  RESULTS
  The potential role of nicotine replacement therapy (NRT) products in a harm reduction strategy is currently severely restricted by strict regulations on dose, safety and potential addictiveness. As a result, NRT products are designed to provide much less nicotine, and deliver it to the brain more slowly, than cigarettes, which are widely accessible and poorly regulated. Smokeless tobacco (snus) has proved to be an acceptable reduced hazard alternative to smoking in Sweden, but supply of snus is illegal elsewhere in the European Union.
  
  
  CONCLUSIONS
  To increase accessibility and reach more smokers, barriers to the use of NRT use need to be removed and more effective NRTs need urgently to be developed. Smokeless tobacco could also play an important role in harm reduction, but current European Union regulations and concerns over exploitation by tobacco companies currently preclude wider use.
  
  
  CONCLUSIONS
  To improve public health there is an urgent need for an appropriate regulatory framework and regulatory authority at the European level, controlling both tobacco and nicotine products to ensure that the least harmful products are the most accessible.
authors.affiliation: Public Health, Tobacco Dependence, Rennes, France. jacques.lehouezec@amzer-glas.com
authors.forename: Jacques
authors.initials: J
authors.lastname: Le Houezec
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
authors.forename: John
authors.initials: J
authors.lastname: Britton
mesh_terms: D000818:Animals; D040261:Harm Reduction; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D009538:Nicotine / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000331:legislation & jurisprudence / Q000379:methods; D019460:Tobacco Industry / Q000331:legislation & jurisprudence; D014029:Tobacco Use Disorder / Q000628:therapy; D014030:Tobacco, Smokeless / Q000009:adverse effects
chemical_list: D009538:Nicotine